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MARSHFIELD CLINIC PHARMACY
CAH521323-05 Memorial Medical Center
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Covered Entity Details
Entity Name
Memorial Medical Center
Subdivision Name
MCHS-Greenwood - Greenwood Clinic
Type
Critical Access Hospital
340B ID
CAH521323-05
Entity Address
102 W Cannery Street
Greenwood, WI 54437
Medicare Provider Number
521323
Outpatient Facility Provider Number
Participating Start Date
4/1/2022
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MARSHFIELD CLINIC PHARMACY
Pharmacy Address
1000 N OAK AVE
MARSHFIELD, WI 54449
Pharmacy Comments
Contract Details
Approval Date
4/13/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sally Zillman, Chief Administrative Officer, MMC - Neillsville
(715) 819-8227
Contract Pharmacy Representative
Marshfield Medical Center
Kirstia Neuendorf, 340B Program Manager
(715) 858-4308
Signed By Date
4/13/2022
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